Cognitive facet and paradigm of the caregivers of children with developmental problems in Eastern India.

Background: The role of caregivers in grooming the neuro-developmental outcome of high-risk newborns and developmental challenges in children needs to be explored. Objectives: To find the knowledge and perception among parents regarding the neuro-developmental outcome of high-risk newborns, methods adopted to address these problems, and to identify areas on which awareness generation needs to focus. Materials and Methods: A questionnaire-based awareness survey was conducted to understand the knowledge, attitude, and practices of families of children with developmental challenges. Results: The study revealed that more than 70 percent of families lack information about child development, developmental challenges, and means to deal with them. They are unaware of the available health care services and other resources. One in three families has misconceptions on developmental disabilities; consider them as curse or jinx and consequently neglected. Female children with developmental problems are further ostracized due to gender inequity in families. About 10 percent of families have shown great openness toward acquiring new skills and knowledge for handling their children with developmental delays. Conclusions: This study is based on the précis research findings of our grass-root level fieldwork conducted in remote rural Bengal areas. The observation will be of interest and learning materials for general primary care practitioners, family physicians, and stakeholders to initiate appropriate intervention strategies for properly rehabilitating children with developmental delay at grass-root levels of primary health care.

Knowledge and perception regarding adverse drug reactions among undergraduate medical students of Bihar, Eastern India.

Background: Adverse drug reactions (ADRs) have national and international monitoring and are part of teaching-learning of undergraduate medical course and curriculum. Objectives: To find the knowledge and perception of ADRs among undergraduate medical students in a tertiary care teaching institute in eastern India. Materials and Methods: This was an observational cross-sectional study conducted among the MBBS medical students by administration of pre-designed, pre-tested, semi-structured questionnaires. The data on their knowledge and candid reflections on ADRs were analyzed question by question using software and compared with peers. Results: The responses from the participants on knowledge and perception of ADRs varied widely. Final-year students had the most precise response on classification, filing an ADR report, national reporting centers, and the first step in monitoring ADRs; the majority accepted their first- hand experience and legal and professional responsibilities on ADRs. Third-year students responded well on objectives, methods, and scope of patients on direct reporting or drug overdose and monitoring; respect patient confidentiality while reporting; and expect feedback from monitoring centers, with special training on ADR. Second-year students responded well on definitions, pharmacovigilance programs in India, alertness of banned drugs because of ADR, and related capacity building. Conclusions: The awareness and insight on ADRs of the undergraduate medical students were quite reasonable. However, further reinforcement is needed in future to be updated to relevant issues to their practice as primary care physicians.

Blood-based biomarkers for diagnosis, prognosis, and severity prediction of COVID-19: Opportunities and challenges.

The reasons for high morbidity and mortality with Corona virus disease (COVID-19) disease remain unanswered with extremes of manifestation and uncertainty of modes of transmission for which biomarkers are urgently needed for early prediction of severity and prompt treatment. We have reviewed publications from PubMed (years 2019-2021) analysing the biochemical, immune-inflammatory, nucleic acid, and cellular biomarkers that predict infection, disease progression in COVID-19 with emphasis on organ-specific damage. Our analysis of 65 biomarkers assessing the impact of SCoV-2 infection on five organs (lung, liver, cardiac, kidney, and neural) reported that increased levels of CRP, TNF-α, ferritin, IL-6, D-dimer, Procalcitonin, Fibrinogen to Albumin Ratio (FAR), and decrease platelet count (PC), lymphocyte count, leukocyte count, and CD4+/CD8 + ratio shows promising association in the early diagnosis, prediction of prognosis and severity disease and also correlates with cytokine storm a cardinal feature of COVID-19 progression. In the above scenario, this review has put forth the most promising biomarkers for COVID diagnosis and prognosis based on the reported literature. In recent year's chemically synthesized antibody-like biomolecules, aptamers were also used in the diagnosis of COVID-19 which could be preferably used for diagnosis over antibodies. Biomarkers including increase in free DNA and Fibrinogen-to-Albumin Ratio, CRP, PCT, and Ferritin along with a consequential decrease of CD3+ T, CD4+ T, CD8+ T, NK cells with corresponding increase in CD4+/CD8+ ratio following SARS CoV-2 infection has been consistently correlated with disease severity. Despite the two waves of COVID-19 pandemic, currently there is no standard clinical practice guideline for evaluating the severity of the devastating pandemic of COVID-19, hence these biomarkers will have immense relevance for the third and subsequent wave of COVID-19 and related pandemic.

Correlates of depression among school going adolescents in the urban area of Patna in eastern India.

Background: Depression is a hidden pandemic among adolescents with multi-factorial causal risk and risk correlates. Objectives: To find the prevalence of depression and risk factors among school-going adolescents. Methods: A cross-sectional study was conducted among 838 adolescents enrolled in 6th-11th standards (age: 11-19 years) in 15 urban schools in Patna city by using the modified Patient Health Questionnaire-9 (PHQ-9); binary logistic regression was applied to find significant risk correlates. Results: Depression was noted among 51.2% adolescents of our study participants: mild 32.3%, moderate 14.3%, moderately severe 3.9%, severe depression 0.6%; among early adolescents (46.2%; boys-21.2%, girls-78.8%) and among late adolescents (55.3%, boys-34.7%, girls-65.3%). Adolescent depression was significantly associated in our study with female gender, late adolescence, higher classes (9th-11th), vegetarian diet, soft drink consumption, fast foods, screen time, domestic harassment, academic dissatisfaction, parental discord as well as mental illness. Girls had higher risk who were in higher classes, on a vegetarian diet, habitually on soft drink, more screen time (>3 h), face more family nuisance, parents brawling frequently, and suffering from known mental diseases. Conclusion: Depression was noted in more than half of the adolescents, with a higher prevalence in girls, scholastic failure, higher grades, vegetarian diet, more screen time, familial disease, and conflict.

Prevention of hospital-acquired infections: A construct during Covid-19 pandemic.

INTRODUCTION: Hospital-acquired infection (HAI) rates were reported to have declined in healthcare settings during the Covid-19 pandemic. Needless to mention that HAI is of paramount interest and relevance to a primary care physician who need to care from womb to tomb inside pandemic. OBJECTIVES: This study was conducted to find the impact of Covid-19 pandemic on the four parameters of HAIs, namely, catheter-associated urinary tract infections (CAUTI), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs) with hand hygiene compliance rates among healthcare workers. MATERIALS AND METHODS: This retrospective data mining was undertaken in a 700 bed multispecialty teaching hospital in the Eastern India which was a Government of Bihar approved speciality Covid Care Hospital. Data from the monthly routine infection control monitoring and surveillance activities was collated from January 2019 to December 2020. Control charts with upper and lower control limit set at mean ± 1 SD were used to monitor monthly trends of HAIs. RESULTS: The CAUTI rates reduced by 28.01%; the CLABSI rates declined by 37.61%, the SSI rates reduced by 62.39%, while the highest VAP rates were reported in November 2019 (1.9 per 1000 ventilator days). The hand hygiene compliance rates from January 2019 to December 2020 among different healthcare staffs showed a sharply rising trend. CONCLUSION: Covid-19 pandemic highlighted paramount importance regarding compliance to hand hygiene and implementation of standard infection control practices as recommended by World Health Organisation and Centres for Diseases Control and Prevention (CDC), which can drastically reduce range of HAIs.

Exploratory study on the operational issues faced in collection, transportation, and laboratory testing related to COVID-19 in remote areas of selected EAG states of North East and East India.

BACKGROUND: COVID-19 ongoing pandemic has proved beyond doubt that all countries in the world from high income to low- and middle-income countries were unprepared with under-diagnosed and underreported losses of precious human lives on already overstretched healthcare delivery infrastructure. Thus, the urgent need of the hour is to understand and identify the operational issues and challenges encountered in the sample collection process and also at the testing labs in order to respond at the earliest. This early and effective response will help not only to address the identified issues in the whole chain of sample collecting to test result communication but also it will help to improve the functioning of the entire system involved in this process. OBJECTIVES: The present study was undertaken to identify the issues faced during various steps involved in laboratory testing as part of the COVID-19 control activities in selected remote districts of North East and East India. Further, perceived adequacy of human resources, equipment, diagnostic kits, and other essential consumables including PPEs vis-a-vis the load of samples received from the catchment areas of the testing laboratories were also explored. METHODS: The study was a qualitative research using in-depth interview method to collect and collate the data from the chain of personnel involved in sample collection, storage, transportation, and testing by recorded telephonic interview by state-level collaborators as per the study protocol. The respondents were recruited from randomly selected sites of remote districts for sample collection, storage, transportation, and dedicated testing labs in six states of North East and Eastern India. The study findings were analyzed by two-dimensional scaling and hierarchical cluster analysis to get the collective picture involving transcription, preliminary data scrutiny, content analysis, and interpretation of the verbal IDI; classified and summarized by triangulation; free listing and pile sorting of suggestions. RESULTS: The entire laboratory testing related human resources has been working on war-footing round-the-clock to fulfil the expectation of the stakeholders and maintaining high quality despite the ever-increasing load of sample testing in both the public and private sectors. The findings indicated that the healthcare workers from all levels of laboratory diagnosis have taken it as a challenge to control the pandemic even with limitations of logistics to capacity building. Positive suggestions to improve laboratory services were to increase human resources, infrastructure, IT with the robust mechanism of monitoring and supervision. CONCLUSIONS: Upgradation of laboratory capacities and expertise in public health has become one of the points of concern to contain the COVID-19 pandemic of the new millennium.

COVID-19 pandemic and safety of taxi services: Looking beyond primary care.

The COVID-19 pandemic is a lifetime experience of 'Living within a pandemic' for the vast majority world over. Public health principles based on equity should be at the core of world's response to it. Service professionals such as taxi/cab drivers are no exception. It is a challenge for them to establish mechanisms for making taxi services safer with regards to SARS COV2 spread, and thereby regain the confidence of stakeholders in this necessary public service. This requires a comprehensive planning taking into account the socio-economic stresses, psychosomatic health and other determinants, and yet being able to adapt and innovate for safer services. These considerations and decisions have to be based on available as well as emerging research evidence about this infection both in the lab and in the community. Targeted safety interventions that translate and apply research findings hold promise. While the course of the pandemic remains uncertain, life must find a 'new normal' and people need to get back to the business of regular living. The purpose of this review is to study the various risks to the stakeholders in taxi/cab services, and draft strategies for mitigating these risks from a theoretical and practical perspective.

Safe drinking water and toilet facility in public places in India: What we need to do!

There is abundant literature on domestic safe water supply and hygienic sanitation. Yet, there is a paucity of research studies on adequate supply of safe drinking water and toilet facilities in places of population movement and congregation in India. This study stresses on the importance of availability of safe water and sanitation facilities in all the places of human congregation and movement in India. 49 research studies were identified from 169 potentially relevant publications. Studies were selected: first, all protocols of water and toilet facilities among published literature were meticulously searched. Second, information sources on sanitation facilities in public life, viz., railways, roadways, waterways, market places and shopping complexes, schools, and other higher educational institutions, fairs and festivals, entertainment establishments, healthcare facilities, were explored from publications of various resources of different levels. Third, published reports from apex bodies of national and international importance like Indian Council of Medical Research, World Health Organization (WHO), UNICEF, USAID, etc. were given due weightage. Of late, the concept of cleanliness and making communities free from open defecation are in limelight as the Government of India has taken up Swachh Bharat Mission (SBM); even then, contextual gaps remain. This is the cause for concern as both safe water supply and basic sanitation are directly linked to health promotion of the community. Further, this research group have noted that due importance has not been integrated in the planning of SBM regarding availability of safe water and scientific sanitation facilities in all the places of human movement and congregation. Hence, there is more need for creating awareness among general population as well as stakeholders regarding this aspect of cleanliness. It is noted that despite considerable improvement in safe water and sanitation facilities in domestic life, there is considerable population left, who are still lacking access to these facilities in public space.

Safer Roads to School.

Any and all advances made by medical science cannot solve the problem of road traffic injuries (RTIs) in school-going children, especially if the only concerned people are those of the medical fraternity. Children are a vulnerable part of the traveling population and thus have been persistent due to the callous nature of the citizens and policy makers toward road safety and injury prevention. In our multicultural and multilingual country, there is a need for multistakeholder initiative with a countrywide presence if we are to stem the rise of mortality and morbidity due to these accidents. The first question we need to ask is how to prevent road traffic accidents and improve the condition of our roads. Pediatric RTIs are eternal problem of industrial revolution with complications and effects that may affect individual and society with increase in the number of motorized communications. Dedicated capacity building is urgently need who should be able to provide the necessary care to the injured children at the road crash spot as well as should be informed where to take the injured child and whom to contact in the dedicated injury care center while transporting the victims of situations.

Cognition, autonomic function, and intellectual outcomes of the paramedical health-care personnel in the hospital settings.

BACKGROUND: In the dedicated intensive care settings, health-care providers need to have higher temporal cognition and sympathovagal balance to optimally deliver critical care interventions. OBJECTIVE: The objective of the study was to estimate the parameters of the temporal cognition and autonomic function of paramedical staffs in acute health-care settings. MATERIALS AND METHODS: In this study on 81 healthy adult paramedical personnel, temporal cognition was assessed using auditory reaction time (ART), visual reaction time (VRT), critical flicker fusion frequency (CFFF), Stroop test (ST), and digits forward test (DFT); Autonomic functions were assessed by heart rate (HR) and blood pressure (BP) variability, and all these outcomes were analyzed with their academic performance. RESULTS: Out of 81 healthy adult nonteaching technical personnel, majority was female; the mean age was 25.10 ± 3.93 years. Age and gender were not significantly related with screen times in terms of smartphone use, playing video games, or regularly using computer; academic performances were also not significantly related with screen times in terms of smartphone use, playing video games, or regularly using computer. In the conventional domains, during analysis of physiological and psychological variables under study, there was no significant relation with screen times when compared with HR, systolic BP, diastolic BP, mean arterial pressure, body mass index, ART, VRT, CFFF, ST, and DFT. Playing video games and regular computer use were significantly correlated with age, gender, AP, CFFF, ST, and DFT. CONCLUSION: This study on paramedical personnel showed a positive relation of temporal cognition and sympathovagal autonomic balance with performing a task or function.

The Outcome Analysis and Complication Rates of Tracheostomy Tube Insertion in Critically Ill Neurosurgical Patients; A Data Mining Study.

OBJECTIVES: To assess the impact, timing, the intra and early post-operative complications and the survival outcome of tracheostomy in critically ill neurosurgery patients. METHODS: This study was a retrospective data mining where data was collected from hospital records from 175 consecutive patients who underwent tracheostomy in the department of Neurosurgery at the Narayna Medical College Hospital, Nellore, India from Jan 2016 to April 2018. A proforma was used to note down the details on the patient status before and after tracheostomy: Glasgow coma scale (GCS), procedure and intra and post-operative complications, type of tracheostomy cannula, details of decannulation, respiration difficulties, and problems with wound, swallowing difficulties, and voice difficulties, stay in intensive care unit (ICU) and hospital and survival status of the patient. RESULTS: In our series, mean age of TBI cases was 47.42±16.62; mean hospital stay and ICU stay was 18.81±10.22 and 12.58±7.36 days respectively. In all age groups, more tracheostomy was needed in cranial injury cases and surgery was major intervention. Commoner complications were mucous deposition (6.86%), blockage of tracheostomy canula (6.29%), bleeding from multiple attempts (6.06%), excessive bleeding (2.94%). Cranial injury needed tracheostomy more in all age groups and more done at operation theatre without significant improvement of GCS score. Survival was statistically higher after tracheostomy irrespective of GCS status or venue of intervention. CONCLUSION: Tracheostomy should be considered as soon as the need for airway access is identified during intervention of the critically ill neurosurgical patients.

Competency-based medical education: How far, how much.

Competency-based medical education inscribed in the Graduate Medical Education Regulations from Medical Council of India is cogently grounded by the Curriculum Implementation Support Programme throughout the country under the aegis of Medical Education Units and Curriculum Committees of the medical institutes. Global researchers on academic curriculum visualize paradigm of system based teaching-learning in evidence based medicine. This intermingled with participatory contribution from the learners in a non-threatening environment can inculcate philosophy of life-long learning mindset. Creative teaching-learning environments free the mind to freely learn to meet the challenges of the health needs of the country.

Intervention on malaria awareness among 'Bedia' tribal community in West Bengal, India.

BACKGROUND: Tribals have a vulnerable health status because of malarial morbidities, yet they ignore their illnesses and do not go to physicians during sickness for several reasons including poverty. OBJECTIVE: This qualitative research project attempted to create awareness among 'Bedia' tribal to initiate preventive and other personal protective measures against malaria. METHODS: Initially, efforts were made to create malaria awareness by literate 'Bedia' volunteers who were trained to do so; however, their tribal fellows were reluctant to receive awareness efforts from them. After thorough analysis and interaction, a novel "interprofessional team" of composer, vocalist, and instrumentalists approach was made to impart malaria awareness by composing songs in the language of the aborigine. Then health education was imparted to the 'Bedia' participants by the trained 'Bedia' through theme songs with their rustic music instruments and group dance performances in the intermingled media from the team. An evaluation was done to assess usefulness of the health education intervention by the researchers. RESULTS: Overall, 137 adult 'Bedias' in 42 families (M = 74; F = 63) participated in our study. In the informal feedback session, only 51 adult males and 46 adult females could furnish expected results. Out of the 42 families residing in the village, 11 houses consistently used mosquito bed nets before the awareness program; after the awareness program, it became 15 as was demonstrated by using social mapping. CONCLUSIONS: Our project activities on the Bedia tribes could unearth required interventions of awareness about malaria. However, it was possible to create awareness and confidence among them so that they could themselves take necessary preventive measures and positive approaches toward malaria.

WACEM Consensus Paper on Deep Venous Thrombosis after Traumatic Spinal Cord Injury.

The risk and outcome of deep vein thrombosis (DVT) in patients who sustained spinal cord injury (SCI) remain a challenge. We aimed to assess the incidence, risk, burden, and prophylaxis of DVT after SCI. Thirty-nine studies were identified from among 250 relevant articles based on firstly, broad criterion of DVT among SCI cases. secondly, "risk factors" impacting DVT, thirdly, published reports from apex bodies of global importance such as World Health Organization, Centre for disease control, Atlanta USA, and others were given due weightage for their authenticity. SCI is characterized by loss of motor, sensory, and autonomic function with partial or total damage of the anatomical structure leading to increased risk of thrombogenesis. SCIs present a higher risk of venous DVT constituting 9.7% of deaths in the 1st year of follow-up. Currently, prophylaxis with mechanical methods, vena cava filters and antithrombotic chemoprophylaxis in SCI are interventions for the management of DVT. DVT in SCI patients is not uncommon and needs a high index of suspicion and implementation of institutional prophylaxis protocol.

Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India.

Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population - children, pedestrians, cyclists, motorcyclists, and the elderly - are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.